Involuntary psychiatric hospital treatment among 12- to 17-year-olds in Finland: A nationwide register study

Sourander, André; Korkeila, Jyrki; Turunen, Merja-Maaria

doi:10.1080/08039489850139382

Cited by 12 publications

(18 citation statements)

References 2 publications

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“…The strongest predictor for involuntary hospitalisation was having intellectual disability (OR 15·74, 95% CI 10·82–22·90). 27 Sourander and colleagues 39 also found that a diagnosis of psychosis and older age (15–17 years vs 12–14 years) were significantly associated with involuntary hospitalisation on multivariate analysis, controlling for gender, whether or not it was a first admission, whether they were admitted to an adult or adolescent unit, and the treatment year. On stepwise multiple logistic regression analysis, So and colleagues 38 found that any DSM-IV Axis 1 diagnosis, high risk of suicide, danger to others, previous compulsory care, and lack of motivation or compliance all predicted involuntary rather than voluntary hospitalisation.…”

Section: Resultsmentioning

confidence: 95%

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Walker

Barnett

Srinivasan

et al. 2021

The Lancet Child & Adolescent Health

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Background Disparities in involuntary psychiatric hospitalisation between population subgroups have been identified in adults, but little is known about the factors associated with involuntary hospitalisation in children or adolescents. We did a systematic review, meta-analysis, and narrative synthesis to investigate the social and clinical factors associated with involuntary psychiatric hospitalisation among children and adolescents.Methods We searched MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials for studies of any type up to July 22, 2020, that compared the characteristics of voluntary and involuntary psychiatric inpatients (mean age of sample ≤18 years). We synthesised results using random effects meta-analysis on unadjusted data and by narrative synthesis. Heterogeneity between studies was calculated using I². This study is registered on PROSPERO, CRD42020099892.Findings 23 studies from 11 countries were included in the systematic review and narrative synthesis, of which 19 studies (n=31 212) were included in the meta-analysis. On meta-analysis, involuntary rather than voluntary hospitalisation of minors was associated with a diagnosis of psychosis (eight studies; odds ratio 3•63, 95% CI 2•43-5•44, p<0•0001), substance misuse (five studies; 1•87, 1•05-3•30, p=0•032), or intellectual disability (four studies; 3•33, 1•33-8•34, p=0•010), as well as presenting with a perceived risk of harm to self (eight studies; 2•05, 1•15-3•64, p=0•015) or to others (five studies; 2•37, 1•39-4•03, p=0•0015). Involuntary hospitalisation was also found to be associated with being aged 12 years or older (three studies; 3•57, 1•46-8•73, p=0•0052) and being from a Black rather than a White ethnic group (three studies; 2•72, 1•88-3•95, p<0•0001). There was substantial between-study heterogeneity for most factors included in the meta-analysis (I² from 51•3% to 92•3%). Narrative synthesis found that more severe illness and poorer global functioning was associated with involuntary hospitalisation.Interpretation Over-representation of involuntary psychiatric hospitalisation in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors.

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Section: Resultsmentioning

confidence: 95%

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Walker

Barnett

Srinivasan

et al. 2021

The Lancet Child & Adolescent Health

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“…(Kaltiala‐Heino, Korkeila, Tuohimäki, Tuori, & Lehtinen, 2000; Richer‐Rossler & Rossler, 1993; Salize & Dressing, 2004; Sanquienti, Samuel, Schwartz, & Ropetson, 1996; Tuohimäki et al, 2003). There are limited national studies based on adolescent population which deals with involuntary treatment (Kaltiala‐Heino, 2004; Sourander et al 1998; Worall et al, 2004). The two Finnish nation‐wide studies Sourander et al (1998) and Kaltiala‐Heino (2004) were based on hospital discharge registers, which limits the reliability of the results.…”

Section: Introductionmentioning

confidence: 99%

The involuntary treatment of adolescent psychiatric inpatients—A nation‐wide survey from Finland

Ellilä¹,

Sourander²,

Välimäki³

et al. 2007

Journal of Adolescence

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This national cross‐sectional study investigates the prevalence rates, regional differences and factors associated with the involuntary inpatient treatment of adolescents in Finland on a chosen day in 2000. The proportion of inpatients with involuntary legal status was 29.5% (n=82) giving a prevalence rate of 2.5 per 10,000/12–17 years old inhabitants.Forty‐eight per cent of involuntarily inpatients were 16–17 years old and 62% had psychotic disorders. Twenty‐six per cent of inpatients with involuntary legal status were voluntarily admitted. Regional differences of involuntary treatment were rather modest. Psychotic disorders, suicidal acts, and substance use disorders were independently associated with involuntary legal status.There is a need for further studies to investigate the long‐term effects of involuntary treatment on the adolescents’ subsequent well‐being. Further studies on alternatives methods for involuntary treatment are warranted, likewise the clinical guidelines for involuntary treatment practices.

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“…The number of hospital beds for adolescents, in contrast to other psychiatric beds, has increased, but they are still neither sufficient nor equally distributed among regions. Minors still have to be treated in adult psychiatric wards (19), even if this is prohibited by Finnish law (Table 1), and adolescents have to wait for too long for both hospital and outpatient treatment. It now appears that the demand for psychiatric services among adolescents is much higher than that estimated by the Task Force in 1987 (although the estimation was then considered to be too high).…”

Section: Discussionmentioning

confidence: 99%

A new priority in psychiatry: Focused services for adolescents

Laukkanen¹,

Pylkkänen²,

Hartikainen

et al. 2003

Nordic Journal of Psychiatry

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Finland was the first European country to give a high priority to the development of specialized psychiatric services for adolescents. The aim of this paper is to 1) describe the development of these services, 2) study the status and the functioning of psychiatric services for adolescents in 2000 and 3) present some future challenges. The data have been collected from the social welfare register, from a questionnaire sent to Health Districts and via telephone interviews. In addition, the functioning of the treatment system has been studied in detail in one Health District by means of interviews and questionnaires. The general targets set in 1987 giving national priority to focused psychiatric services for adolescents were mostly reached in 2000, and resources for adolescents have increased markedly. In spite of this, minors still have to be treated in adult psychiatric wards. Many problems were detected in the functioning of the chains of treatment for adolescents. The differentiation between primary and secondary care was unclear. Primary care had a limited capacity in the early detection of mental disorders in adolescents. The services for adolescents were broken down into small units. Furthermore, there were no comprehensive future plans. The need for specialized psychiatric services for adolescents is evident. In addition to developing adequate resources, the quality of care should also be guaranteed by training and by competent long-term planning of psychiatric service systems.

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Involuntary psychiatric hospital treatment among 12- to 17-year-olds in Finland: A nationwide register study

Cited by 12 publications

References 2 publications

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

The involuntary treatment of adolescent psychiatric inpatients—A nation‐wide survey from Finland

A new priority in psychiatry: Focused services for adolescents

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